Sítios simbólicos de pertencimento e prevenção e controle da tuberculose: percepções e práticas dos Agentes Comunitários de Saúde no Brasil e na Etiópia / Symbolic sites of belonging and prevention and control of tuberculosis: perceptions and practices of community health workers in Brazil and Ethiopia

Resumo O objetivo do artigo é avaliar a contribuição do DOTS comunitário, do inglês "Directly Observed Treatment Short-Course", nas ações de prevenção e controle da tuberculose na atenção primária no Brasil e na Etiópia, a partir das percepções e práticas dos agentes comunitários de saúde (ACS). Utilizou-se o referencial conceitual e metodológico dos sítios simbólicos de pertencimento, com suas três tipologias: caixas preta, conceitual e operacional. Empregou-se o estudo de dois casos contrastantes, triangulando e complementando informações advindas de entrevistas semiestruturadas com ACS e profissionais de saúde e também observação participante. Os achados destacam o sentido de comprometimento dos ACS como um valor importante nas ações desenvolvidas em ambos contextos. Os principais desafios são a insuficiência de capacitação e supervisão das ações realizadas (caixa conceitual), assim como as dificuldades de acesso (caixa de ferramentas), expressas em distâncias geográficas no caso etíope e em barreiras relacionadas à violência no território, não explicitadas, no contexto brasileiro. Isto implica em um esforço contínuo dos ACS para adaptar suas práticas, respeitando os valores culturais (caixa preta) que dão sentido e direção às suas ações na superação dos desafios.

Abstract This article aims to evaluate the contribution of Community DOTS, Directly Observed Treatment Short-Course, for the prevention and control of Tuberculosis actions in primary care in Brazil and Ethiopia, based on the perceptions and practice of the community health care workers. We employed the Symbolic Sites conceptual-methodological framework, accounting for its three types: Black box, Conceptual box, and Toolbox. The contrasting case study involved triangulating and complementing data collection and analysis from semi-structured interviews with community health workers and health professionals, site observation, and document analysis. The results highlight a sense of commitment as an essential value regarding the activities developed by community health workers in both contexts. The main challenges are the insufficient capacity building and supervision (Conceptual box), and the difficulties related to access (Toolbox), expressed in long geographic distances in the Ethiopian case and barriers related to territory violence, mostly drug trafficking, although not explicit, in the Brazilian context. This implies in a continuous effort for the community health workers to adapt their practices, respecting the cultural values (Black box), in order to direct their actions to overcome these challenges.

Prevalence of Tooth Decay and Associated Factors Among Ethiopian Patients

Abstract Objective: To assess the prevalence of tooth decay and it's associated factors among the age group of 15-20 years old visiting Ayder Comprehensive Specialized Hospital. Material and Methods: An epidemiological cross-sectional descriptive study was conducted among 384 subjects aged 15-20 years. A closed-ended questionnaire, according to the World Health Organization methodology was used to collect the data. The subjects were examined for the presence of tooth decay using the DMFT Index. One examiner was trained and standardized using a Kappa test (K=0.90). To test the differences in the DMF-T index related to socioeconomic variables, the Chi-square and the Mann-Whitney tests were employed. For all tests, the level of significance was set at p≤0.05 with 95% Confidence level. Results: The magnitude of tooth decay among study participants was 57.8%. The mean decayed, missed and filled was 1.26 and prevalence was higher in males (34.1%). Poor oral hygiene practice was strongly associated factor with tooth decay. 56.2% of visitors from the urban area were mainly affected by tooth decay. Conclusion: Tooth decay is highly prevalent among visitors between15-20 years of age. Tooth brushing habit, residency, and consumption of sugary food and drinks were significantly associated with the occurrence of tooth decay. Early diagnosis and prompt treatment can prevent further damage.

Programa de cooperación quirúrgica en un hospital rural de Etiopía. ¿Podemos ofrecer cirugía de calidad? / Surgical Cooperation Program in a Rural Hospital of Ethiopia. Can we Offer Quality Surgeries?

RESUMEN Introducción: En Etiopía la asistencia quirúrgica en el medio rural es deficitaria por la falta de cirujanos y por los limitados recursos sanitarios, y este escenario subóptimo puede provocar un incremento de morbilidad y mortalidad operatoria. Objetivos: Describir las intervenciones quirúrgicas realizadas durante ocho años de cooperación en el Hospital Rural de Gambo y analizar la morbilidad y mortalidad posoperatoria. Método: Se realizó un estudio descriptivo, retrospectivo, de las intervenciones quirúrgicas practicadas en el Hospital Rural de Gambo, por un grupo de cooperación quirúrgica entre 2007-2017 en ocho campañas quirúrgicas. Se recogieron en una base de datos el sexo, edad, diagnóstico, tipo de cirugía (urgente o programada), operaciones realizadas, complicaciones posoperatorias, infecciones del sitio quirúrgico, morbilidades, reintervenciones, transfusiones de sangre y mortalidad posoperatoria. Resultados: Se operaron 587 pacientes, 389 de cirugía general, 78 de obstetricia-ginecología, 77 lesiones urológicas y 38 pacientes de traumatología. El 13 por ciento (89) pacientes fueron operados de urgencia. Se aplicó anestesia general con intubación traqueal a 143 pacientes, anestesia raquídea en 167 casos y anestesia local en 277. En cirugía mayor (310 pacientes), la mortalidad fue 2 por ciento, con 5,3 por ciento de infección del sitio quirúrgico, 3 reintervenciones (1 por ciento) y 9 (3 por ciento) transfusiones sanguíneas perioperatorias. Conclusiones: Para la cooperación quirúrgica en el entorno rural de Etiopía es necesaria una formación adicional en cirugía obstétrica-ginecológica, urología y traumatología. A pesar de los escasos medios tecnológicos del Hospital Rural de Gambo es posible realizar una cirugía mayor con seguridad, con un bajo índice de infecciones de herida, de necesidades transfusionales, reoperaciones y mortalidad(AU)

ABSTRACT Introduction: In Ethiopia, surgical assistance in rural areas is deficient due to the lack of surgeons and limited health resources. This suboptimal setting can cause an increase in morbidity and surgical mortality. Objectives: To describe the surgical interventions carried out during eight years of cooperation in Gambo Rural Hospital and analyze the postoperative morbidity and mortality. Method: A retrospective and descriptive study of the surgical interventions performed at Gambo Rural Hospital was carried out by a surgical cooperation group between 2007-2017 in eight surgical campaigns. Sex, age, diagnosis, type of surgery (urgent or scheduled), carried out operations, postoperative complications, surgical site infections, morbidities, reoperations, blood transfusions and postoperative mortality were collected in a database. Results: 587 patients were operated on: 389 for general surgery, 78 for obstetrics-gynecology, 77 urological lesions, and 38 for traumatology. 13 percent (89) patients were operated urgently. General anesthesia with tracheal intubation was applied to 143 patients, spinal anesthesia was used in 167 cases and local anesthesia was used in 277 cases. In major surgery (310 patients), mortality was 2 percent, with 5.3 percent of surgical site infection, 3 reinterventions (1 percent) and 9 (3 percent) perioperative blood transfusions. Conclusions: Additional training in obstetric-gynecological surgery, urology and traumatology is necessary for surgical cooperation in the rural setting of Ethiopia. Despite the scarce technological means of Gambo Rural Hospital, it is possible to perform major surgery safely, with a low rate of wound infections, transfusion needs, reoperations and mortality(AU)

Stock assessment of fishery target species in Lake Koka, Ethiopia / Evaluación de las reservas pesqueras de especies objetivo en el lago Koka, Etiopia

Effective management is essential for small-scale fisheries to continue providing food and livelihoods for households, particularly in developing countries where other options are often limited. Studies on the population dynamics and stock assessment on fishery target species are thus imperative to sustain their fisheries and the benefits for the society. In Lake Koka (Ethiopia), very little is known about the vital population parameters and exploitation status of the fishery target species: tilapia Oreochromis niloticus,common carp Cyprinus carpióand catfish Clarias gariepinus.Our study, therefore, aimed at determining the vital population parameters and assessing the status of these target species in Lake Koka using length frequency data collected quarterly from commercial catches from 2007-2012. A total of 20 097 fish specimens (distributed as 7 933 tilapia, 6 025 catfish and 6 139 common carp) were measured for the analysis. Von Bertalanffy growth parameters and their confidence intervals were determined from modal progression analysis using ELEFAN I and applying the jackknife technique. Mortality parameters were determined from length-converted catch curves and empirical models. The exploitation status of these target species were then assessed by computing exploitation rates (E) from mortality parameters as well as from size indicators i.e., assessing the size distribution of fish catches relative to the size at maturity (L m),the size that provides maximum cohort biomass (Lopt) and the abundance of mega-spawners. The mean value of growth parameters L x, Kand the growth performance index 0' were 44.5 cm, 0.41/year and 2.90 for O. niloticus,74.1 cm, 0.28/year and 3.19 for C. carpioand 121.9 cm, 0.16/year and 3.36 for C. gariepinus,respectively. The 95 % confidence intervals of the estimates were also computed. Total mortality (Z) estimates were 1.47, 0.83 and 0.72/year for O. niloticus, C. carpioand C. gariepinus,respectively. Our study suggest that O. niloticusis in a healthy state, while C. gariepinusshow signs of growth overfishing (when both exploitation rate (E)and size indicators were considered). In case of C. carpio,the low exploitation rate encountered would point to underfishing, while the size indicators of the catches would suggest that too small fish are harvested leading to growth overfishing. We concluded that fisheries production in Lake Koka could be enhanced by increasing Etoward optimum level of exploitation (E opt)for the underexploited C. carpioand by increasing the size at first capture (Lc)toward the L opt range for all target species.

Un manejo pesquero eficiente es fundamental para que las pesquerías artesanales puedan continuar proveyendo alimento y sustento para los hogares, particularmente en los países en vía de desarrollo, en donde otras opciones a menudo son limitadas. Estudios sobre la dinámica poblacional de las especies objetivo de las pesquerías son, por lo tanto, imperativos para mantener las pesquerías y los beneficios para las sociedades. Esto también es válido para los recursos del Lago Koka (Etiopia) en donde hasta ahora se sabe muy poco sobre los parámetros poblacionales vitales y el estatus de las especies objetivo como la tilapia Oreochromis niloticus,la carpa Cyprinus carpioy el bagre Clarias gariepinus.El estudio aquí presentado tiene como objetivo determinar estos parámetros y evaluar el estado de la pesquería de estas especies en el lago Koka, utilizando los datos de frecuencia de tallas obtenidas de capturas trimestrales en el periodo 2007-2012. Un total de 20 097 especímenes fueron medidos (7 933 de tilapia, 6 025 de bagre y 6 139 de carpa). Los parámetros de crecimiento de von Bertalanffy fueron derivados del análisis de progresión de las modas usando ELEFAN I y aplicando la técnica de jackknife. Las tasas de mortalidad fueron estimadas de curvas de capturas basadas en longitudes y usando modelos empíricos. La tasa de explotación (E), se estimó con los parámetros de mortalidad y también considerando indicadores del tamaño a través de la distribución de tallas en las capturas y su relación con la talla de la primera madurez (L m),el tamaño que provee la biomasa máxima del cohorte (L opt)y la abundancia de los "mega-desovantes". Los valores calculados para los parámetros de crecimiento L m, Ky el índice de la capacidad de crecimiento 0' fueron: 44.5 cm, 0.41 año-1 y 2.90 para O. niloticus,74.1 cm, 0.28 año-1 y 3.19 para C. carpióy 121.9 cm, 0.16 año-1 y 3.36 para C. gariepinus,respectivamente. La tasa de mortalidad total (Z) fue estimada en 1.47, 0.83 y 0.72 año-1 para O. niloticus, C. carpioand C. gariepinus,respectivamente. Nuestros resultados sugieren que la población de O. niloticusse encuentra en un estado saludable, mientras C. gariepinusya muestra signos de sobrepesca por crecimiento. En el caso de C. carpiolas tasas de explotación tan bajas (E<0.5) que se encontraron, pueden apuntar a una sub-explotación, mientras que los indicadores de tallas sugieren que las pequeñas tallas obtenidas, pueden conducir a una sobrepesca por crecimiento. Concluimos que la producción pesquera en el lago Koka puede ser mejorada si se incrementa E al nivel E opt para C. carpioy aumenta el tamaño de la primera captura (Lc)al rango de L opt para todas las especies objetivo.

Treatment outcome of human immunodeficiency virus and tuberculosis co-infected patients in public hospitals of eastern and southern zone of Tigray region, Ethiopia

Background: Tuberculosis is a leading cause of death among people living with human immunodeficiency virus. In sub-Saharan Africa, tuberculosis accounts for more than 78% of all deaths among people with human immunodeficiency virus. Objectives: To assess tuberculosis treatment outcome and the associated factors in adult tuberculosis/human immunodeficiency virus co-infected patients in four public hospitals of eastern and southern zone of Tigray region, Ethiopia. Methodology: Institution based cross-sectional study design was used to examine secondary data from tuberculosis/human immunodeficiency virus co-infected patients attending four public hospitals of eastern and southern zone of Tigray, from January 2009 to August 2011. Systematic random sampling technique was used to select individual patient cards from the respective hospitals. Univariate analysis and multivariate logistic regression modeling was used to assess the impact of each variable in predicting treatment outcome. Results: Out of 342 patients included, 199 (58.2%) patients completed treatment, 43 (12.6%) patients were cured, 88 (25.7%) died, 7 (2%) defaulted, and 5 (1.5%) patients failed treatment. Treatment success rate was around 71%. In the multivariate logistic regression analysis the factors that were strongly associated with unfavorable tuberculosis treatment outcomes were WHO stage IV (AOR = 3.2, CI = 1.58-6.82, p-value = 0.001), age greater than 45 years (AOR = 6.08, CI = 2.28-16.23) and baseline CD4 count less than 200 cells/L (AOR = 6.19, CI = 2.28-16.89, p-value = 0.001). Conclusion: The rate of treatment success in this study was lower than the rate newly recommended by WHO. Therefore, efforts should be undertaken to improve treatment success rates of both diseases. .

Ethnobotany of medicinal plants of northern Ethiopia / Etnobotánica de plantas medicinales del norte de Etiopía

An ethnobotanical survey based on semistructured questionnaires among 35 farmers was carried out in two regions in Tigray, northern Ethiopia. Ethiopia is one of the poorest countries in the world with low level of medical care; therefore indigenous knowledge of medicinal plants is highly priced information and can be a good source of income to family or community. In total, 58 plant species were detected, while 48 plants, and 44 genera, belonging to 27 families have been identified as medicinal. Vernacular, as well as scientific names, plant part used, way of use and modes of preparation and application are included. Majority of plants were used for various gastrointestinal disorders, sprains treatment or to heal bronchitis, however, interesting aspects are the uses of plants to cure bilirubinemia, prostate disorders, syphylis and milk ingest disorders.

En dos regiones del Tigray (Tigré), en el norte de Etiopía se realizó un estudio etnobotánico, basado en un cuestionario semiestructurado, entre 35 agricultores. Etiopía es uno de los países más pobres del mundo con un bajo nivel de atención médica, por lo tanto, el conocimiento autóctono de las plantas medicinales es una información muy valiosa y puede ser una buena fuente de ingresos para la familia o comunidad. En total, se detectaron 85 especies de plantas, de las cuales fueron identificadas como plantas medicinales 48 especies y 44 géneros pertenecientes a 27 familias botánicas. En el estudio están incluídos los nombres vernaculares y científicos, como también parte de la planta utilizada y su forma de uso, modos de preparación y aplicación. La mayoría de las plantas se usan para el tratamiento de diversos trastornos gastrointestinales y esguinces o para curar la bronquitis; sin embargo, son interesantes los usos reportados para tratar la bilirrubinemia, dolencias de la próstata, sífilis y la intolerancia a la lactosa.

Treatment outcome of tuberculosis patients under directly observed treatment in Addis Ababa, Ethiopia

BACKGROUND: Tuberculosis is one of the leading causes of mortality among infectious diseases worldwide. For effective tuberculosis control, it is a pre-requisite to detect the cases as early as possible, and to ensure that the tuberculosis patients complete their treatment and get cured. However, in many resource-constrained settings treatment outcome for tuberculosis has not been satisfactory. OBJECTIVE: The aim of the study was to assess the treatment outcome of tuberculosis patients and investigate the association of demographic and clinical factors with treatment success of patients enrolled in Directly Observed Treatment Short Course program in government owned health centers over the course of five consecutive years in Addis Ababa, Ethiopia. METHODS: A register based historical cohort study covering the period of July 2004 to June 2009 was conducted to determine the treatment outcome of Directly Observed Treatment Short Course in government owned health centers in Addis Ababa. Sex and age of tuberculosis patients, health center at which the patient was treated, year of treatment, type of tuberculosis for which the patient was treated, type of treatment offered to the patient, follow-up status and documented treatment outcome were extracted from the Directly Observed Treatment Short Course clinics of three randomly selected health centers. RESULT: Records of 6450 registered tuberculosis patients (n = 3147 males and 3433 females) were included in this document review. Of these patients 18.1% were reported as being cured, 64.6% were documented as treatment completed, 3.7% died during follow-up, 5.1% were reported as defaulters, 0.4% were documented as treatment failure and 8.2% were transferred out to another health institution. Treatment center and year of enrollment were significantly associated with treatment success. CONCLUSION: Year of enrollment and treatment center were significantly associated with treatment success. Although the overall treatment success obtained in this study is in line with the World Health Organization (WHO) target, continuous follow-up of patients with frequent supportive supervision during the course of treatment, and further investigate the cause for the observed difference in treatment success across treatment centers are recommended.

Mycobacterium leprae virulence-associated peptides are indicators of exposure to M: leprae in Brazil, Ethiopia and Nepal

Silent transmission of Mycobacterium leprae, as evidenced by stable leprosy incidence rates in various countries, remains a health challenge despite the implementation of multidrug therapy worldwide. Therefore, the development of tools for the early diagnosis of M. leprae infection should be emphasised in leprosy research. As part of the continuing effort to identify antigens that have diagnostic potential, unique M. leprae peptides derived from predicted virulence-associated proteins (group IV.A) were identified using advanced genome pattern programs and bioinformatics. Based on human leukocyte antigen (HLA)-binding motifs, we selected 21 peptides that were predicted to be promiscuous HLA-class I T-cell epitopes and eight peptides that were predicted to be HLA-class II restricted T-cell epitopes for field-testing in Brazil, Ethiopia and Nepal. High levels of interferon (IFN)-γ were induced when peripheral blood mononuclear cells (PBMCs) from tuberculoid/borderline tuberculoid leprosy patients located in Brazil and Ethiopia were stimulated with the ML2055 p35 peptide. PBMCs that were isolated from healthy endemic controls living in areas with high leprosy prevalence (EChigh) in Ethiopia also responded to the ML2055 p35 peptide. The Brazilian EChigh group recognised the ML1358 p20 and ML1358 p24 peptides. None of the peptides were recognised by PBMCs from healthy controls living in non-endemic region. In Nepal, mixtures of these peptides induced the production of IFN-γ by the PBMCs of leprosy patients and EChigh. Therefore, the M. leprae virulence-associated peptides identified in this study may be useful for identifying exposure to M. leprae in population with differing HLA polymorphisms.

Neutralization of bitis parviocula (Ethiopian mountain adder) venom by the south african institute of medical research (SAIMR) antivenom / Neutralização do veneno de Bitis parviocula (serpente da Montanha da Etiópia) pelo antiveneno do Instituto Africano de Pesquisa Médica (SAIMR)

BACKGROUND: The Ethiopian mountain adder (Bitis parviocula) is a viperid known only from a few locations in southwestern Ethiopia. METHODS: a total of 30 µg of B. arietans and B. parviocula venoms were run on a 10-20 percent Tricine gel. To assay lethality dose fifty (LD50), five groups of eight mice for each venom were used. Hemorrhagic activity for crude venom was tested. Fibrinogenolytic activity of crude venom was measured using (2.5 mg/mL) of fibrinogen solution and (0.03 mg/mL) of crude venom. Gelatinase activity of the venom was tested on a Kodak X-OMAT TM film. Crude venoms of B. parviocula and B. arietans were tested for their abilities to affect clotting time, clotting rate and platelet function on whole human blood. RESULTS: The (SAIMR) antivenom was confirmed in this study to neutralize the lethal activity of venom from Bitis parviocula. The ED50s of SAIMR antivenom on B. parviocula and B. arietans neutralized half of 18.2 and 66.7 mg of venom, respectively. The hemorrhagic activities (MHDs) of B. parviocula and B. arietans were 0.88 and 1.7 µg, respectively. Bitis arietans and B. parviocula venoms degradated α and β chains at different times. The γ chains remained unaffected. Bitis parviocula venom did not exhibit gelatinase activity, while B. arietans had a MGD of 6.9 µg. At 3 mg/mL, the crude venoms of B. parviocula and B. arietans did not significantly affect clotting time or clotting rate. CONCLUSIONS: The SAIMR antivenom is very effective in neutralizing the venom of B. parviocula and should be considered in treating envenomations by these snakes.

BACKGROUND: Serpente das Montanhas da Etiópia (Bitis parviocula) é um viperídeo conhecido somente em poucas localizações do sudoeste da Etiópia. MÉTODOS: Um total de 30 µg de veneno de B. arietans e B. parviocula foram corridos em gel de 10 a 20 por cento de tricina. Para se estabelecer a quinquagésima dose de letalidade (LD50) foram usados cinco grupos de oito camundongos para cada veneno. A atividade hemorrágica para o veneno cru foi testada. A atividade fibrogenolítica do veneno cru foi medida usando 2,5 mg/mL de solução de fibrinogênio e 0,03 mg/mL de veneno cru. A atividade de gelatinase do veneno foi testada em um filme KODAK X-OMAT TM. Venenos crus de B. parviocula e B. arietans foram testados no que diz respeito à sua capacidade de afetar o tempo de coagulação, a velocidade de coagulação e a função plaquetogênica em sangue humano total. RESULTADO: o antiveneno SAIMR foi confirmado neste estudo no que diz respeito à neutralização da atividade letal do veneno de Bitis parviocula. ED50s do antiveneno SAIMR sobre a B. parviocula e B. arietans neutralizou metade de 18,2 e 66,7 mg respectivamente do veneno. As atividades hemorrágicas (MHDs) de B. parviocula e B. arietans foram respectivamente 0,88 e 1,7 µg. Os venenos de B. arietans e B. parviocula degradaram cadeias α e β em tempos diferentes. A cadeia Γ permaneceu não afetada. O veneno da B. parviocula não mostrou atividade de gelatinase, enquanto o de B. arietans teve um MGD de 6,9 µg. A nível de 3 mg/mL os venenos crus de B. parviocula e B. arietans não afetaram significantemente o tempo e a velocidade de coagulação. CONCLUSÕES: O antiveneno SAIMR é bastante efetivo para neutralizar o veneno da B. parviocula e deveria ser considerado para o tratamento de envenenamentos por estas serpentes.

Baja prevalencia de las neurosis obsesivas y obsesivo-compulsivas en nuestro medio / Low prevalence of obsessive neurosis an obsessive-compulsive in our enviroment

Se estudian ocho pacientes portadores de neurosis obsesiva y obsesivo-compulsiva, en un cohorte histórico de 18 años, en consultorio privado, en nuestro medio. Se analizan las variables de sexo, edad, estado, civil, procedencia, las medias de edad de inicio y la consulta psiquiátrica por la patología. Los antecedentes heredológicos para la detección de patología similar y rasgos de personalidad OC; otras patologías, afines. Los antecedentes personales, haciendo resaltar las etapas escolar y de desenvolvimiento sexual, cuando surgen las primeras dificultades en el paciente. El cuadro clínico con la sintomatología fundamental, y la orientación terapéutica planteada. Se confirma la baja prevalencia de la neurosis obsesiva y OC. Y sus características invalidantes cuando severas y no tratradas

Vólvulo del sigmoides. Morbilidad y mortalidad. Estudio de 63 pacientes / Sigmoid volvulus. Morbidity and mortality. Study of 63 patients

Se realiza un estudio de 63 pacientes que presentaron obstrucción intestinal por vólvulo del sigmoides, a los cuales se les trató por diferentes métodos en el Hospital Yekatit 12, de Addis Abeba, Etiopía, durante el período de agosto de 1988 a julio de 1990. Esta afección se presentó en el 87,3 por ciento de los pacientes con más de 50 años y es la causa más frecuente de obstrucción intestinal en dicha región, pues representa el 75,0 por ciento de la serie estudiada. Se trataron médicamente de urgencia por medio de la reducción no quirúrgica del vólvulo del sigmoides un total de 12 pacientes, para el 19,0 por ciento de la serie; en el 75,0 por ciento de ellos se obtuvo la reducción del vólvulo, mientras que en el 25,0 por ciento restante se fracasó. Los resultados del tratamiento quirúrgico de urgencia por la técnica de la desvolvulación, mostraron una recurrencia del 55,5 por ciento. La mortalidad por tratamiento médico es cero, y por tratamiento quirúrgico es 13,7 por ciento. Dentro de las distintas formas de tratamiento quirúrgico, el de resección y anastomosis primaria presenta el 23,8 por ciento de mortalidad